Basic Information
| Provider Information | |||||||||
| NPI: | 1346213089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANOWITZ | ||||||||
| FirstName: | LIZA | ||||||||
| MiddleName: | BENNETT | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 921B JASONWAY AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432142330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142688800 | ||||||||
| FaxNumber: | 6144478876 | ||||||||
| Practice Location | |||||||||
| Address1: | 921B JASONWAY AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432142330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142688800 | ||||||||
| FaxNumber: | 6144478876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 08629 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 2660740 | 05 | OH | MEDICAID |